Provider Demographics
NPI:1841871126
Name:BOSEMANI, THANGA G
Entity type:Individual
Prefix:
First Name:THANGA
Middle Name:G
Last Name:BOSEMANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 RACE RD STE 403
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2386
Mailing Address - Country:US
Mailing Address - Phone:443-248-1929
Mailing Address - Fax:
Practice Address - Street 1:1232 RACE RD STE 403
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-2386
Practice Address - Country:US
Practice Address - Phone:443-868-7101
Practice Address - Fax:443-732-0054
Is Sole Proprietor?:No
Enumeration Date:2021-04-18
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR207565207QA0505X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine